Oral contrast for abdominal and pelvic CT: Difference between revisions

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==Background==
==Background==
For patients undergoing CT of abdomen and/or pelvis
*Oral contrast considerations for patients undergoing CT of abdomen and/or pelvis
*Pros: May add improved imaging characteristics for some patient groups
*Cons: Requires significant "lead time" (i.e. must administer >1hr prior to CT scan) and can result in delays to care
 
==Indications for Oral Contrast==
===Desirable===
*Suspected fistula or bowel leak
*Suspected [[intussusception]] or internal hernia
 
===May Consider===
*Suspected low-grade [[bowel obstruction]]<ref name="ACR">American College of Radiology ACR Appropriateness Criteria® https://acsearch.acr.org/docs/69476/Narrative/</ref>
**For suspected high-grade [[bowel obstruction]], oral contrast is contra-indicated (wastes time, adds expense, can induce further patient discomfort, will not add to diagnostic accuracy, and can lead to complications, particularly vomiting and aspiration)<ref name="ACR" />
*Intra-abdominal [[abscess]] depending on the suspected primary source
**May not be required if primary source is skin infection
*Metastatic evaluation
*Suspected [[Hernia]]
*[[Appendicitis]] or [[Diverticulitis]] with BMI <20
**"Oral or rectal contrast may not be needed depending on institutional preference."<ref name="ACR" />
**"Evidence is trending against the routine use of oral contrast, and particularly against the routine use of rectal contrast, for CT when IV contrast is used."<ref name="ACR" />


==Redypaque Dose==
==Redypaque Dose==
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'''Weight'''
'''Weight'''


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Max = 300cc
Max = 300cc
==Oral Contrast Indications==
===Desirable===
* [[appendicitis]] or [[diverticulitis]] with BMI <20
**if CT indicated; consider immediate surgical consultation
*[[intra-abdominal abscess]] with concern for a fistula or bowel leak
*suspected fistula or bowel leak
*suspected [[intussusception]] or internal hernia
===Consider===
*suspected low-grade [[bowel obstruction]]
*intra-abdominal abscess depending on the suspected primary source
**may not be required if primary source is skin infection
*metastatic evaluation
*suspected [[hernia]]
===Not Indicated===
*emergent process needing immediate CT
*delays in time to imaging due to prolonged intolerance of oral contrast
*uncomplicated [[appendicitis]] or [[diverticulitis]] with BMI >20
*suspected high-grade or severe [[bowel obstruction]]
*suspected aneurysm, dissection, or vessel thrombosis
*suspected bowel ischemia or infarct
*[[renal stone]] protocol orurograms
*pancreatic protocol for [[pancreatitis]] or mass
*liver protocol for liver mass or abscess
*adrenal protocol for adrenal mass or nodules
*superficial abdominal wall infections or abscesses
*[[inflammatory bowel disease]]


==See Also==
==See Also==
*[[Contrast with Renal Dysfunction]]
*[[Contrast-induced nephropathy]]
*[[Creatinine Screening for CT with Contrast]]
*[[Creatinine screening prior to IV contrast]]


== Source ==
==References==
*Harbor-UCLA Medical Center Guideline, "Emergency Department Oral Contrast Guidelines"
<references/>
*American College of Emergency Physicians Guidelines
*American College of Radiology Guidelines
*Mink 7/2010


[[Category:Rads]]
[[Category:Radiology]]
[[Category:Nephro]]
[[Category:Renal]]
[[Category:Peds]]
[[Category:Surgery]]

Latest revision as of 14:58, 14 October 2019

Background

  • Oral contrast considerations for patients undergoing CT of abdomen and/or pelvis
  • Pros: May add improved imaging characteristics for some patient groups
  • Cons: Requires significant "lead time" (i.e. must administer >1hr prior to CT scan) and can result in delays to care

Indications for Oral Contrast

Desirable

  • Suspected fistula or bowel leak
  • Suspected intussusception or internal hernia

May Consider

  • Suspected low-grade bowel obstruction[1]
    • For suspected high-grade bowel obstruction, oral contrast is contra-indicated (wastes time, adds expense, can induce further patient discomfort, will not add to diagnostic accuracy, and can lead to complications, particularly vomiting and aspiration)[1]
  • Intra-abdominal abscess depending on the suspected primary source
    • May not be required if primary source is skin infection
  • Metastatic evaluation
  • Suspected Hernia
  • Appendicitis or Diverticulitis with BMI <20
    • "Oral or rectal contrast may not be needed depending on institutional preference."[1]
    • "Evidence is trending against the routine use of oral contrast, and particularly against the routine use of rectal contrast, for CT when IV contrast is used."[1]

Redypaque Dose

Weight

Give 1 hour prior to scan

Give 30 minutes prior to scan

Give immediately upon arrival to CT

< 2 kg

None or as ordered by physician

None or as ordered by physician

None or as ordered by physician

2-5 kg

30 mL

30 mL

30 mL

>5-20 kg

90 mL

90 mL

90 mL

>20-50 kg

150 mL

150 mL

150 mL

>50 kg

300 mL

300 mL

300 mL

(100cc/age)/3 = dose x 3

Max = 300cc

See Also

References

  1. 1.0 1.1 1.2 1.3 American College of Radiology ACR Appropriateness Criteria® https://acsearch.acr.org/docs/69476/Narrative/